Primary Nursing Diagnosis

Dorn Spinal Therapy

Spine Healing Therapy

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Body image disturbance related to anxiety over thickened skin and enlargement of face, hands, and feet

OUTCOMES. Self-esteem; Body image; Anxiety control

INTERVENTIONS. Body image enhancement; Coping enhancement; Emotional support; Self-esteem enhancement; Support group; Anxiety reduction

^ PLANNING AND IMPLEMENTATION Collaborative

SURGICAL. The goal of treatment is to normalize pituitary function. Pituitary adenomas are frequently removed by a transsphenoidal hypophysectomy through an incision in the upper lip. After the gland is removed, a muscle graft is used to pack the dura and prevent leakage of cerebral spinal fluid. When the incision is closed, nasal packing and a mustache dressing are used to tamponade the area. A transfrontal craniotomy may be used if the tumor is large or if a transsphe-noidal approach is contraindicated. Because many patients have macroadenomas, complete tumor resection with cure of acromegaly may be impossible and radiotherapy may be used to prevent regrowth and control symptoms.

POSTOPERATIVE. After surgery, assess the patient's neurological status and report significant changes. Also check for the presence of pain. Antibiotics, antipyretics, and analgesics may be used to control infection and pain. Check nasal drainage for the presence of glucose, which indicates cerebrospinal fluid drainage. Monitor blood glucose. Growth hormone levels generally fall rapidly after surgery, thus removing an insulin-antagonist effect and possibly causing hypo-glycemia. Pituitary dysfunction occurs in about one-fifth of patients after surgery and requires glucocorticoids, gonadotropins, and thyroid replacement hormone therapy. Radiotherapy may also be used postoperatively to prevent tumor regrowth.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Octreotide

100 mg SC tid; or in

Somatostatin analog

Suppresses growth hormone secretion

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